The Downer Side of War

War is hell, and one way to deal with it is to drink your troubles away – even if U.S. troops are barred from consuming alcohol in war zones.

But nothing apparently stops many of them once the troops are back home. A new federal study reports that binge-drinking among active-duty troops jumped 34% from 1998 to 2008. Nearly half the troops – 47% — had five or more drinks at a single event in 2008 (four drinks or more for women). Heavy drinkers represented 15% of the U.S. military in 1998; that number in 2008 had risen to 20% (still below 1980’s 21%).

You can also pop pills: prescription drug abuse among active-duty U.S. troops doubled from 2% to 4% between 2002 and 2005, and reached 11% in 2008 – a 450% increase in six years.

Combining booze and pills leads to a startling finding in a study released Monday by the Institute of Medicine, part of the National Academy of Sciences: substance abuse accounted for more time spent in hospitals by U.S. troops last year than any of the other 138 medical conditions and injuries tracked by the Pentagon. The growing abuse is one of the pathologies of the wars in Afghanistan and Iraq, along with increases in post-traumatic stress disorder, depression and suicides.

IOM

Among the 352-page report’s other findings:

— Analyses of record data by the military indicate that alcohol and drug use disorders have been increasing in recent years for the active duty component, the reserve component, and military dependents.— Collectively, the data indicate that excessive alcohol use is a much greater substance use problem than illicit drug use or prescription drug misuse.— Rates of acute and chronic incident alcohol diagnoses increased from 2001 through 2010, especially during the latter part of the decade for the active duty component…The number of bed days attributable to chronic alcohol abuse diagnoses roughly quadrupled over the 10-year period.— Several Army reviews have identified a high proportion of suicides, other deaths, and other negative consequences associated with untreated SUDs [substance use disorders].— Compared with their civilian counterparts, active duty component military personnel were found to be more likely to engage in heavy drinking (a finding driven by personnel aged 18-35); less likely to use illicit drugs (excluding prescription drug misuse) among all age groups; and less likely to use illicit drugs (including prescription drugs) among younger personnel aged 18-25, but more likely to use these drugs among those aged 36 or older (a finding driven by prescription drug misuse).

On the good news front: self-admitted (anonymously) use of illicit drugs by active-duty troops over the past 30 days fell from 28% in 1980 to 3% in 2008.

“Alcohol and other drug use in the armed forces remain unacceptably high, constitute a public health crisis, and both are detrimental to force readiness and psychological fitness,” the report’s summary says. “The highest levels of military leadership must acknowledge these alarming facts and combat them using an arsenal of public health strategies, including proactively attacking substance use problems before they begin by limiting access to certain medications and alcohol.”

IOM

The chairman of the panel that wrote the report lauded steps taken by the Pentagon to deal with substance-abuse challenges, but says more needs to be done.

“Better care for service members and their families is hampered by inadequate prevention strategies, staffing shortages, lack of coverage for services that are proved to work, and stigma associated with these disorders,” said Charles P. O’Brien, psychiatrist and head of the Center for Studies of Addiction at the University of Pennsylvania. IOM creates panels made up of independent scientists and academics to provide policy-makers with expert advice on challenging issues.

The IOM panel lauded the Army’s Confidential Alcohol Treatment and Education pilot program, which it said shows “that active-duty service members use confidential treatment when given the opportunity to do so.” It encouraged the Army to expand its program and that the other services replicate it.

The alternating horrors and humdrummedness of waging war has always made substance abuse a problem: it was rum in the Revolution, and opium addiction became known as the “soldier’s disease” during the Civil War. “The military has a long history of use and abuse of alcohol and other drugs,” the study acknowledges, “and substance use often is exacerbated by deployment and combat exposure.”